2008-402 TOWN OF QUEENSBURY
I
742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
�I III
- Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080402-35139 Date Issued: Monday, October 20, 2008
This is to certify that work requested to be done as shown by Permit Number P20080402-35139
has been completed.
Tax Map Number: 289.9-1-85
Location: 308 GLEN LAKE RD
Owner: Nancy Choppa
Applicant: Nancy Choppa
This structure may be occupied as a:
904 sq ft residential alteration & 1 FIREPLACE By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080402 Application Number. A20080402
Tax Map No: 523400-289-009-0001-085-000-0000
Permission is hereby granted to: NANCY J CHOPPA
For property located at: 308 GLEN LAKE Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: NANCY J CHOPPA
308 GLEN LAKE Rd Residential Alteration $12,000.00
LAKE GEORGE, NY 12845-0000 Total value $12,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-402
904 sq ft residential alteration
$90.40 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,July 30, 2009
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at e To of e ns�ury;® esday,July 30, 2008
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code Enforcement
k
Fire Marshal's Office
1 J:rYt. (3t Ow,t7 Sb tzry° ifE! 137ff R()a('" { dil eYl sbIiY./, lVew York °12804 + i
Michael f. Fr�lrr�r, Fire kfarshal•Gary Stillman, Depnt,u Fire k arshal t ;
f
r
APPLICATION FOR FUEL BURNEVG APPLIANCE & CHIMNEYS
Application is hereby made to the Building&Codes Office for the issuance of a Building& Use Permit
pursuant to the New York State Fire Prevention &Building Code. The applicant or owner agrees to comply
with all applicable laws, ordinances,regulations, and all conditions that are part of these requirements and
also will allow all inspectors to enter premises to perform required inspections.
IMPORTANT NOTE TO APPLICANT: ROUGH-IN AND FINAL INSPECTIONS ARE REQUIRED.
OWNER: /��AI G W x CHO 10)0 - INSTALLER/BUILDER: Aa4,4 Cz�1= —
ADDRESS: I&W 41±� ADDRESS:
PHONE NOS. '713 .3539 PHONE NOS. /
LOCATION OF PROPERTY: 64'W G 1<,CW l�AV SUBDIVISION NAME: Al IA-
LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: cV/NG payor'l
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: AulceeweF_ e4iV I+A PHONE: S 1�►yL�_
✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL
INFORMATION
STOVE
FIREPLACE INSERT
FIREPLACE,FACTORY BUILT* I�
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY)
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAME: &2cH FiwzO MODEL NO. 1>V- 5 20
LISTED BY: NUMBER: W 6k-2095
QUESTIONS?
CALL 7614205 or 761-6206
CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL:
firemarshal@gueensbury.net
MASONRY"* CHECK ONE ✓ VISIT OUR WESSITE
TILE STEEL SIZE IN FOR MORE INFORMATION
INCHES www.+gueensbury.net
FLUE CHECKONE ✓
DOUBLE CHIMNEY
WALL TRIPLE WALL INSULATED DIRECT VENT LINER
CHIMNEY MATERIAL CHECK ONE ✓ 01�
**IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: /600 5- MODEL NO.
ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION&BUILDING CODE AND/OR
MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED
INSPECTIONS.
-_ -I/,OFFICE USE ONLY ,.__... .I
06-102
; TAX MAP NO. PERMIT NO.
FEES: PERMIT D RECREATION ENGINEERING '
(If applicable)
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: (-7rzrjt `- 'F C OWNER:
ADDRESS: Lts�: ADDRESS:
i '�
PHONE NOS. .� 5J 3 7 PHONE NOS. c `>
CONTACT PERSON FOR BUILDING & CODES COMPLIANCE:(47Ai, vt. PHONE:
LOCATION OF PROPERTY: `vriom3�, P�-, C, -t L5
SUBDIVISION NAME: A
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT p w �
APPLY TO YOUR Z E- O cn O
PROJECT O '�; O O O F' _
O � o = Fes- O - z
z Q Q ;- � N � 0U- I-- U- d = «s
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED I
GARAGE(1,2,3)
OTHER
IF COMMERCIAL OR INDUSTRIAL- NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: �� FUEL TYPE: IL
HEAT TYPE: H��� r'� -HOW MANY FIREPLACE(S):____L__AND / OR WOODSTOVES(S):
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE?
IS THIS A HISTORIC SITE? lV U, /
PROPOSED USE OF BUILDING OR ADDITION: tJ/ ,
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
B 3-LGL 11-05
Q
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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�- NOTICE
a Smms IECTO S,ARE REQUIRED IN BEDROOMS,
ADJACENT-- QEDR� 6IVIS, AND ON EACH FLOOR LEVEL
INCLU3If CELLAR OR BASEMENT. ALL SMOKE
' - - DETECTORS SHALL BE INTERCONNECTED ON ALL LEVEL(
ALL SMOKE DETECTORS MUST BE BATTERY BACKUP.
CARBON MONOXIDE DETECTOR RIU{RED OUTSIDE
LOWEST SPING LEVEL.
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FOAM IN
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� PAPER III)Ij'LfJl0,
sLL
Town of Qnecnsbnry Rre Muss!
742 Bay Road
Qneambnry,NY 12M
761-SM/761-S2M6
fax 745-4437
Factory Built Gas Firenlaee/Stave Inspection Report
lobcomm New Yo&Stale re"m fiat ad ILL Li h*factory bdt appliances be w9aded a000rdmg to the iastistcfioas and
aped6calions contained it the 1mstalbdm Mammal a00oaepanyi�the gmwu oe.No deviation fromi the aaatfactnrer's
Victim or speei6catioaa is A we&
+eisait# s SaedWleInspection tf� / � "Cue /D 4t*)pu anytime MVector
ruse Address.�, C9�LL•'i 1 cry �� Row*b E�aal�
fp§awe Mammf I �t z �� Model# :4j2& qmk
Breen Ventachory Bea7t Ciinueypbe S'vae Doebie Wad Triple Wad Insdatod
Yes No N/A Cols
floor Protection
3euw ces to Combastibtks(all sides)
Nrestop(s) Vaucal Craw
Wad Flemetr don
lent taearanoes to C mmbash"bks
lent/Chimney Twimination
Mmney beigbt me be 3 feet above roof
mmerafion;2 feet above may coadmmabible
oustitctim withim 18 feet
Shut-Off Valve
�ombastion Air
learth Extension(d any)
Adght
t a rAe-
�C�2S C- c
above
witness operation
rank Placement cd Lth X
Mie-m ON DepL Yam. ram-
Town of Qmmubnry Fine M=*d
742 Bury Road
Qs =dmy,NY 12M4
761-SM/7614096
fax 7454437
Factory Belt Gas Fireplace/Stove Inspection Report
Notice: New Yafc State megogm that all UL Listed,&do"bat apK=w es be idated according to the mean and
�peci6catioas eontmed in the IwItanadon Mammal ac000paalvg the qp§mm No deviation fma tie aandactena's
butn iedons or is Awed
I# Schedide himpecdoolof�Tbae /Q!t;I lw anyt� W 5-
(me �� Address W� (yLG 7 .G41ze-- � Bn�h I rural
►ppliaroe M faebwer Mods d 4VSJl�
lined Vest FarcWy Bat CM=wy---y Fine Sine Domble Wan Triple Wall hu nlated
Yes No N/A Comsaa�eats
9loor Protection
aearances to Combustibles(all sides)
�irestop(s) Vatirad Chase
Wan Ydetr2ien X
Vast Clearances to Combustibles
Vent/Chimney Termination
'grey height and be 3 feet above n wf
woetr flor;2 fed above nary eewbudible OV
VENtmctian within to fed
,^gas Shut-off Valve
Combustion Air
ffearth Extension(if any)
Mantel
Mgbt above Vp
Witness Operation
rank Placement(if LF)
wNfe-DWINft DePL vim. ri.t-F%m hIarAd
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit Not _.,..... . ..... . L."l_.......-Cert. N 0 4584 Cut-in Card No.....................................
Owner...............................�'.x //o
�C ......................................................................
Location..... .pp........ L6! L !K . ..... � " i
............. .............. ................................I. ' .... ..
Instal ation Consisting of.. �.. j. ?...!� �.:. (?...1.f..s L ..Qr,C1.�. ............
.f. .... s.................................................................................
....................................................................................................................................................................................
InstalledBy.......... .. G.'�........................................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of mak' inspections at any time, and if its
rules are violated,the Company shall have the right to rev a th' c ifica .
Date....d.'.Z�..d...................... INSPECTOR.... .......... . ........................................................................